Insertion of arterial and venous catheters for angiography and acute care of patients is a major source of discomfort, morbidity, and even mortality. The problem of accurate location and penetration of arteries and veins is especially acute for patients who may be obese or present unusual anatomy and who are undergoing cardiac catheterization and other radiological procedures such as cerebral angiograms.
To avoid difficulties when localizing the vessel and to reduce the risk of complications, it is known to determine the position and the course of the vessel to be penetrated by means of ultrasonic Doppler sonography. Known apparatus emits an ultrasonic beam from the skin surface toward the interior of the body. If any blood vessels are present within this ultrasonic beam, the emitted wave undergoes a Doppler effect due to flow through the blood vessels or the pulsation of the vascular walls, so that a reflected wave that has a different frequency from that of the emitted wave can be obtained.
After this reflected wave has been converted into an electrical signal with an ultrasonic oscillator, synthetic detection of the emitted signal allows an electric signal of the difference of the two waves to be obtained. This can be amplified and sent to a speaker or the like to produce a sound having a unique tone that can be detected by the ear. These sounds reach their maximum volume when the ultrasonic beam is directed toward the center of the artery or vein in question and cease if the ultrasonic beam strays from the vessel. Further, the reflected wave from tissue that has no movement cannot be heard nor can the sound resulting from vessels that are out of the line of the beam. Hence, Doppler sonography provides a simple means of localizing vessels both easily and accurately.
The potential utility of Doppler ultrasound for accurately guiding a needle into a vessel has been recognized. Most applications utilize the transmission of ultrasonic waves through the needle and reception of ultrasonic echoes by a separate transducer located on the body of the patient and separate from the syringe and needle. Such applications obviously have limited accuracy. U.S. Pat. No. 3,556,079 for "Method of Puncturing A Medical Instrument Under Guidance of Ultrasound" discloses in one embodiment the placement of both transmitting and receiving transducers in the needle and syringe. Such an embodiment, however, requires a special catheter construction and can give an erroneous signal when the needle engages the blood vessel before penetrating the vessel.
A major advance to Doppler technology was made by virtue of U.S. Pat. No. 4,887,606 directed to an "Apparatus for Use In Cannulation of Blood Vessel", which teaches the use of a transducer insert positioned within a hollow needle including an ultrasonic transducer at one end for transmitting and receiving ultrasonic waves through the sharpened end of the needle. Upon location and penetration of a blood vessel, the transducer insert is removable from the needle for implementation of the known Seldinger technique for placing a catheter in a blood vessel. Although the device disclosed in U.S. Pat. No. 4,887,606, the disclosure of which is incorporated by reference herein, represents a superior apparatus for cannulation of blood vessels, such apparatus could be improved upon. For example, the power emitted by a transmitting transducer is at least in part a function of surface area. Thus, larger surface area transducers can deliver more power and thereby increase the depth of penetration of the transmitted and reflected waves.
Since the reflected waves from small vessels that are located at large depths from the surface of the body are weak, it is important in certain applications to increase the depth of penetration of the transmitted and reflected waves. Therefore, there has been a need for an improved apparatus for the cannulation of blood vessels in certain applications.